Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. IV. Service Limits

12/01/1991

A. Total Services Allowed Per Consumer

There is no explicit limit for services per consumer, but the daily reimbursement rates are a de facto limit on services. The nurses say that the payment rate is roughly $5 per hour, therefore level I clients should get 2 hours of service per day, level II clients get 4 hours of service per day, and level III clients get 5 hours per day. There is no real assurance that the consumer receives even this level of daily service. At one public housing project, level III consumers have formed a co-op in order to pool resources and have access to an on-call attendant.

B. Type of Services Offered

1. Paramedical Services

Paramedical services are not allowed in this program. Medications which are "ordinarily self-administered" can be given by the attendant, but because many of these clients are poor and do not have access to adequate health care, nurse case monitors say they must spend a lot of time explaining medication regimes to consumers and attendants.

2. Emergency and Respite Services

There are no mechanisms for provision of emergency or backup services in this program.

3. Homemaker Services

Household services "directly related to medical need and essential to the recipient's health and comfort" are provided by the program.

4. Supervision

Eligibility for the program is defined broadly enough to allow recipients with supervision needs to receive services. One program in Baltimore called Prologue Inc., has apparently had remarkable success in using MAPC services to prevent recurring institutionalization of psychiatric clients.

C. Location of Service Provision

Services are limited to the home or non-institutional settings (i.e. small group homes with less than 4 clients). There is some discussion with the state Developmental Disabilities Administration about using MAPC for other types of group homes, but the DHMH seems reluctant to expand the program.

The program allows for escort to medical appointments, but because the program does not allow reimbursement for transportation expenses and does not allow the attendant to transport the consumer, medical appointments are often missed. The problem is related to the larger crisis in medical services: since all recipients are well below the poverty line, they must rely on inadequate public medical care. In the words of one case monitor, "Nobody is going to take a person on the bus, go to the emergency room, and wait for 5 hours if they're only getting $10 for the day."

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